INFUSION CENTERS: Opportunity for Financial and Personal Success Ronnie J. Garner MD, FCAP Infusion Center Presbyterian Hospital Albuquerque, New Mexico

Why Infusion Centers? Why Pathologists? Why now?

Seminal changes in the delivery of health care Hospitalist Internist & Primary care in transition Managed Care with productivity goals Government regulation Prior Authorizations now the norm Increased overhead Overuse of Emergency rooms Shift to outpatient services

Hospitals Have Competition Heart Centers Surgical Centers Eye Centers Endoscopy Centers Revenue sources are altered

Current Outpatient Infusion Centers Oncology or Rheumatology Services own physician group Limited services and hours Physician not usually on site Typically nurse managed

Many Underserved Providers for Outpatient Infusion Services Internal Medicine Family Practice Ob-Gyn Gastroenterologist Renal Nurse Practitioner Others

Limited Choices for Outpatient Services Rheumatology or Oncology clinics Emergency Room Admission to Hospital Freestanding Commercial Providers Home Health Care

Tremendous Opportunity Hospitals and Clinical Pathology!

What is the Opportunity? Hospital Based Infusion Centers Within the “footprint” of hospital Managed by Clinical Pathology Staffed by Clinical Pathologists Provide suitable outpatient services for all physician groups Multiple referral options for physicians Consultative Services essential & Unique

Why A Hospital Based Infusion Center? It fits the current model of integrated services Outpatient services emphasized Reimbursement is better if hospital based It consolidates a broad range of outpatient services into a single unit. –Infusion Services –Donor services –Apheresis services

Why a Clinical Pathologist Hospital based Contractual relationship already exists Known entity Pathologists already manage departments needed to support an Infusion Center We have or can acquire the required skills

Medical Skills for Success Medical Internship is essential Clinical Pathology Residency Knowledge to assist a variety of medical specialists through patient consultation & management of therapy Comfort dealing with ill patients Skills to evaluate and treat reactions to therapy

Presbyterian Infusion Center Located in Professional building 10,000 sq ft 32 beds and chairs 28 nurses 4 physicians – all clinical Pathologists 1 nurse practitioner

Strategy for Success Admission services Pre-authorizations for all patients Pharmacy on site Assess to laboratory and Transfusion services & rapid laboratory turnaround immediately available Have your own charts and charting system Create no barriers to service

Ancillary Services Tube system directly to laboratory Tube system directly to Blood Bank Resuscitative support from ER Pulmonary services available EKG available Radiology available ER admission available Full gases available (O2, suction)

Hours of Operation Monday-Friday 7:00 am to 6:30 pm Saturday 7:30 am to 5:30 pm Sundays – usually in am 8:00 – 12:00 Apheresis in off hours if urgent 24 hour call-back including holidays Physician always available when patients in unit.

Referring physician options Referring physician writes orders and infusion center provides services Referring physician requests consult by Infusion center physician & we develop therapy plan and treat We collaborate with referring physician to develop therapy plan & then we manage therapy. We evaluate & treat all reactions

Collaborative Medicine Rheumatologic diseases Neurological diseases Transplant rejection Apheresis & photopheresis services Profound fluid & electrolyte imbalance Unusual endocrinology testing Pediatric endocrinology testing

Coagulation referrals Hypercoagulable disorders Bleeding diathesis Factor deficiencies Von Willebrands disease Coumadin reversal Acute ongoing blood loss

Hematology referrals Anemia – acute or chronic Polycythemia-primary or secondary Thrombocytopenia & Thrombocytosis Hemochromatosis IV Iron Transfusions Bone Marrow aspiration & biopsy

Specialized Services Immune function evaluation Infertility immune evaluations Maintenance of Pregnancy Preoperative preparation-Jehovah’s Witness Preoperative preparation-high risk patients & Pediatric patients Antibiotic therapy 7 days weekly

Hospital Consults Post-operative or other bleeding Hypercoagulable issues SIRS patients Heparin associated antibodies IV Iron – Ob-gyn, GI, Pediatric, other Pediatric Hematology & coagulation Hemolysis Immune workups

Presbyterian Infusion Center Patient Visits patients per month each week day on Saturday on Sunday We serve patients from every area of New Mexico

How to build the business No barriers to access Advertise the service Always have a physician available Communicate with the referring physician about problems or issues Make helpful suggestions-share your knowledge – help solve their problem Develop easy forms for physician use

Communicate to referring physician about all relevant issues Be open to any new service Save a few “emergency” beds Know the patient’s medical history –Recent history from referring physician –Consult with the patient –Some patients need admitted to hospital

Helpful Hints if Medicare History & Diagnosis should justify therapy and must be documented in the chart. Diagnosis code for Medicare must justify therapy. CMS may audit Infusion Centers Recent Medical history must be in chart Use different colored charts for different patient types Pre-authorizations recommended

The Reward for Hospitals Excellent Revenue stream Patients enthusiastic about outpatient service Hospital based Infusion Center has better reimbursement than a free standing center All services are pre-authorized & losses are minimal

Reward for Pathologists A fascinating patient mix Practice is across many specialties Develop an expansive knowledge base The service is in demand & needed You can make a difference job opportunities enhanced

DO YOU SEE OPPORTUNITY? ARE YOU FEELING REINCARNATED?

TRANSFORMING PATHOLOGY: Emerging technology driving practice innovation